It’s an image, broken in the darkness by flickering blue and red police lights, that literally took paramedic Joe Ibrahim’s breath away.

And it’s one that returns to him when he least expects it – whether he’s walking down the street or attending a family wedding.

The devastating image is of heavily-pregnant Katherine Hoang in the back seat of a car.

He knows it will haunt him forever.

On September 27, 2018 the NSW Ambulance intensive care paramedic was on his way home from work about 8pm and looked forward to a couple of days off when his phone began to beep.

It’s a day Mr Ibrahim, 36, remembers so acutely, he says “it aches”.

“I pulled over to the side of the road, had a read of it, and went ‘this looks massive’,” he told The Night Watch.

LISTEN: NSW Ambulance paramedic Joe Ibrahim tells The Night Watch of what it was like to attend a nightmare crash where a pregnant woman, her two unborn twins, and her 17-year-old teenage relative died in Sydney’s Orchard Hills.

Mr Ibrahim’s journey home would have to wait. He was being sent to The Northern Rd in Orchard Hills in Sydney’s west.

“They reported that it was a two-car accident,” he says.

“It was a head-on accident … that they’ve got two people who are deceased, one of which was pregnant.

“And we got two people who are still trapped in the cars and in a critical condition.”

As he raced to the scene – so did his heart rate and thought process: what resources will he need?; and how far away are they from a big hospital that can handle the trauma?

“All those little logistical things start ticking away,” he says.

“Your heart begins to rise. You feel yourself heating up a little bit. Despite putting the air conditioning setting up in the car, you start to sort of heat up a little and then you go, right.

“I need to really focus on driving, because I just need to get there, because obviously, you know you’re travelling at quite a high speed.”

As he turned off the M4 and rounded a hill he saw the crash scene for the first time.

Mr Ibrahim realised it would test every aspect of his training and ability — “the plethora of red and blue lights, multiple ambulance vehicles, multiple police” just a small hint to the devastation he was about to walk into.

It was a walk he initially started backwards “to make sure we haven’t missed any further vehicles”.

The first car he came to only contained a driver, trapped and seriously injured.

“I then walked over and had a look at the other car, which was when I really had to step back at that point and think ‘Oh God, how do we even do this’,” he says.

In the front seat was the driver, who was already dead after sustaining injuries so horrific first responders could not tell if they were a man or a woman. In the front passenger seat was a young man, slipping in and out of consciousness and moaning in pain.

But it was the devastation in the back seat that will haunt Mr Ibrahim forever.

“I looked back in the back seat and saw probably, not probably, literally the worst thing that I have seen which I’ve been out as a paramedic,” he says.

“And that was the pregnant lady with the two twins that had died.

“It took my breath away for a moment.

“And I remember, again, my heart rate stepping up that little bit more and almost looking into the distance going ‘this is tragic, absolutely tragic and heartbreaking for this family’.

“But then immediately you go ‘I have a job to do and I’ve got two people who are still alive and quite critical that need our help.

“So I had to pull away from this emotional rollercoaster.”

Killed was young expectant mother Katherine Hoang, 23 and the twin boys she was just weeks away from giving birth to.

Seriously injured in the front seat was her husband Bronco, who would survive but suffer critical injuries. Behind the wheel was another 17-year-old passenger.

The Hoang’s Nissan Tiida was struck head on by a Mazda being driven by Richard Moananu, 29, who would be charged with unlicensed driving and two counts of manslaughter.

It was a week later at a wedding when Mr Ibrahim caught sight of a pregnant woman.

“And I had to double take and immediately that image from the scene came back,” he admits. “The whole thing coming over the hill and seeing it, hearing my colleague’s voice tremble.

“I needed to leave (the wedding), I needed to go outside. I had to take a minute and just have a bit of time out to myself. When nobody was round, there was no music or anything …”

Still today, seeing expectant mothers, Mr Ibrahim says, takes him straight back to that horrific night, to that back seat.

“The human mind is not made, nor is it designed to see the things emergency personnel see,” he adds.

“It is an image that I can almost say will haunt me all the way to the grave. That is something that I will never, ever forget.

“And I could literally see that image every day. Almost every time I glance at a pregnant lady that I’m not ready for, if I’m walking down the street, but I will look over and go ‘oh, she’s pregnant’. And then it almost dawned on me that ‘Oh wow, it’s that image again.

“And then you fall back in the process of why and then it comes back later.”

Mr Ibrahim credits his supportive wife and two little boys with helping him get through those traumatic incidents.

Returning home on that night, Mr Ibrahim says he walked inside and “then had these two beautiful boys come running up to me, which made things a little easier”.

Mr Ibrahim tells The Night Watch he decided to become a paramedic after being injured himself as a teenager and remembering the feeling he had of being helped.

“I wanted to be able to take people’s pain away,” he says.

“Every time that you do save a life, it’s a feeling that you can’t replicate,” he says.